Tainted Azazel is a character added in The Binding of Isaac: Repentance. He is the alternate version of Azazel but his horns are broken with blood leaking from the left stump, and his wings were cut or ripped off. Tainted Azazel is unlocked by reaching Home and using either the Red Key or the Cracked Key to access a special room in one of the walls while playing as Azazel.
Tainted Azazel starts with 3 Black Hearts and has his short Brimstone replaced with a room-long version that is very thin, high-pitched in sound, deals only x0.5 damage per tick and has a shorter duration (unless he actually holds Brimstone).
At the start of charging the Brimstone attack Azazel will fire Hemoptysis, causing a short-range, high-knockback "sneeze" attack that will curse enemies hit with small Brimstone icon that hovers above its head and deal x1.5 damage. Hitting enemies with the Hemoptysis sneeze halves Brimstone's remaining charge time. Enemies will also take damage when knocked into walls or obstacles, and deal damage when colliding with other enemies. Furthermore, enemies cursed by Hemoptysis will take full damage from his Brimstone beam for approximately 5 seconds; if killed during this time with Brimstone, they will explode, dealing damage to nearby enemies and spread the curse to them. The Brimstone curse also applies to any enemies spawned by an enemy already effected by the curse. For example, the enemies and bosses spawned by Mom's Heart will also have the curse if Mom's Heart had the curse at the time.
Brimstone will give Tainted Azazel a regular beam.
Picking up two copies will give Tainted Azazel the powered-up version of the beam.
Likewise, stacking two uses of Sulfur in the same room will also temporarily increase the damage and size of the beam.
It is also worth mentioning that, due to Tainted Azazel's smaller-width Brimstone being functionally identical to 'standard' Brimstone, other synergies such as The Ludovico Technique and A Lump of Coal work the same as they do on Brimstone.
Tech X overrides Hemoptysis, and will fire thin Brimstone rings without the 0.5x damage multiplier.
Spirit Sword overrides Hemoptysis and Brimstone but sword swings will deal increased damage.
The laser ring created by The Ludovico Technique deals full damage without needing to first use Hemoptysis.
In Co-Op, when Tainted Azazel dies, his ghost will maintain his Brimstone and Hemoptysis abilities. The first is weakened by the damage debuff applied to ghostly players, and the second is weakened as it has a very small size when dead.
Ipecac sneezes are harmless to Tainted Azazel, but sneezes from Incubus with Ipecac are capable of damaging Tainted Azazel.
Picking up Lachryphagy as Tainted Azazel turns his brimstone into a short range attack that leaves Lachryphagy tears.